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PubMed1980

Arthrography of the hip in children. Technique, normal anatomy and findings in unstable hip joints.

A method by which bilateral hip arthrography was performed under general anaesthesia in 130 infants and children 1 month to 7 years of age is described. Significant contractures of the adductor muscles had been corrected before the examination. Most of the children were girls with unilateral congenital idiopathic hip instability detected before the age of one year. From films exposed in standardized projections valuable information was obtained about the configuration of the joint cavity and the size and shape of the femoral head. Criteria for normal appearance in infants of ages 2 to 12 months are presented. More reliable details on the relation between the articular surfaces, the radiographic anatomy of the acetabulum and the distribution of the contrast medium were yielded by stereoradiography. Closed reduction was usually accomplished successfully during the arthrography, which made beginning of definitive treatment under the same anaesthesia possible.

Anesthesia, General↗
PubMed1999

Structural bone grafting in arthroplasty for congenital hip dysplasia: 35 hips followed for 5-10 years.

We assessed 35 hip arthroplasties in 30 patients with an average follow-up of 7 years. All patients suffered from secondary osteoarthrosis due to congenital dysplasia. The mean age at the time of surgery was 54 (19-77) years. Part of the femoral head used as a graft was fixed to the superolateral region of the acetabulum. A 100% bone coverage of the acetabular component was achieved initially. The mean support by the graft was 34%. The graft size, measured in the AP view, decreased on average 29% after 7 years. The resorption caused a reduction in cup coverage to 94%. There was no correlation between the clinical outcome and the graft size. Graft resorption occurred in the horizontal and vertical axes, but hardly affected the contact region with the iliac bone. Radiolucent lines according to DeLee were found in zone I in 4, zone II in 6 and zone III in 7 cases. The Harris Hip Score improved from 37-85 points. 1 revision was necessary 7 months postoperatively after cup dislocation.

Adult↗
PubMedDate not supplied

[The correction of the manifestations of the pathological alterations to the hip joints after the reduction of congenital hip dislocation in children].

The paper outlines mechanisms underlying the development and predetermining the forms of hip joint disorders consequent to setting of congenital hip dislocation, the results of a 3-8-year follow-up of relevant 75 cases in children. Individual treatment regimens combined appropriate exercise, biomechanical correction, physiotherapy, acupuncture, manual therapy.

Child↗
PubMed2004

Gait analysis in an osteoarthritis patient with restoration of the hip joint space following contralateral total hip arthroplasty: a case report.

We present the case of a patient who, after undergoing unilateral total hip arthroplasty (THA), achieved pain reduction in the contralateral hip accompanied by restoration of the radiographic joint space. We conducted gait analysis to clarify the dynamic factors affecting the natural course of osteoarthritis (OA). Our findings revealed that the patient walked with exaggerated adduction of the hip following the contralateral THA, causing substantial regeneration of joint loading.

Journal Article↗
PubMed2005

Clinical evaluation of avascular necrosis in patients with sickle cell disease: Children's Hospital Oakland Hip Evaluation Scale--a modification of the Harris Hip Score.

OBJECTIVE: To establish the validity and reliability of the Children's Hospital Oakland Hip Evaluation Scale (CHOHES), a modification of the Harris Hip Score, for the evaluation of avascular necrosis (AVN) in sickle cell disease (SCD). DESIGN: Nonrandomized test-retest. SETTING: Outpatient clinic. PARTICIPANTS: Forty patients with SCD and 3 healthy controls participated. Twenty-six SCD patients (15 males, 11 females; mean age, 25 y) had been diagnosed with AVN. This group was compared with 14 SCD patients without AVN and 3 healthy controls (8 males, 9 females; mean age, 16 y). INTERVENTION: On average, subjects were assessed by 2 physical therapists by using the CHOHES on 3 separate outpatient visits within a 2-week period. MAIN OUTCOME MEASURES: A mixed model with random effects was constructed to compare patient scores on the CHOHES with disease severity as estimated by Ficat staging on plain radiographs. Correlations between and within physical therapists using the CHOHES were calculated to assess intra- and interrater reliability. RESULTS: From the random effects model, the CHOHES mean score was 88 for Ficat stage 0, 75 for Ficat stage I or II, and 61 for Ficat stages III or IV (P < .05). Intrarater reliability estimates for the total CHOHES score were very good (r > or = .87) as were interrater reliability estimates (r > or = .90) between therapists who measured hips with a wide range of CHOHES scores. CONCLUSIONS: The CHOHES appears to be an easy-to-use, valid, and reliable assessment tool and should be considered for use in the routine clinical evaluation of SCD patients with AVN.

Adolescent↗
PubMed2005

Bone mineral density and walking ability of elderly patients with hip fracture: a strategy for prevention of hip fracture.

The main risk factors for proximal femoral fracture include the hazard of falling and osteoporosis. The change in walking ability of patients before injury was evaluated over the last 10 years in a rapidly advancing aging society in Tokyo, Japan. The bone quality of patients was clarified in order to develop a strategy for prevention of hip fractures. The subjects were 157 women with proximal femoral fractures treated between 1989 and 1993 (group A) and 216 women treated between 1999 and 2003 (group B). Bone mineral density (BMD) of the radius of the patients showed slightly lower values than those of the elderly general population, but no statistically significant difference was observed in each age group except for the 75-79-year-old age group (p<0.05). Many patients had problems in walking, and 27% of patients in group A and 44% in group B could not walk outdoors or go shopping alone before the injury, and their bone mineral density was reduced. For the prevention of hip fractures, it is important to improve the physical function to avoid falls, which directly cause hip fracture. Patients who have difficulty performing effective physical exercise because of reduced walking ability require medication for osteoporosis.

Accidental Falls↗
PubMed2004

Ternary complexes metal [Co(II), Ni(II), Cu(II) and Zn(II)]--ortho-iodohippurate (I-hip)--acyclovir. X-ray characterization of isostructural [(Co, Ni or Zn)(I-hip)(2)(ACV)(H(2)O)(3)] with stacking as a recognition factor.

Four ternary metal--ortho-iodohippurate (I-hip)--acyclovir (ACV) complexes, [M(I-hip)(2)(ACV)(H(2)O)(3)] where M is Co(II) (1), Ni(II) (2), Cu (3) and Zn(II) have been obtained by reaction between the corresponding binary complexes M(II)(I-hip)(2)xnH(2)O and ACV. Three ternary complexes (M=Co, Ni and Zn) and the corresponding Zn(II)--ortho-iodohippurate binary derivative have been structurally characterized by X-ray diffraction: The studies show these three ternary complexes are isostructural and present, in solid state, an interesting stacking between the nucleobase and the aryl ring of the hippurate moiety, which probably promotes the formation of ternary complexes. Moreover, the two different ligands interact between them by means of ancillary hydrogen bonds with water molecules coordinated to the metal ion. It must be mentioned that these two recognition factors, hydrogen bonds plus stacking, could explain the reason for the isostructurality of these ternary derivatives with so different three metal ions, with diverses trends in coordination numbers and geometries. In solid state, there are two enantiomeric molecules that are related by an inversion center as the crystal-building unit (as a translational motif) for the ternary complexes.

Journal Article↗
PubMed2003

The stubborn hip: idiopathic avascular necrosis of the hip.

OBJECTIVE: To highlight the unusually indolent course of avascular necrosis in this patient, the risk factors of which chiropractors should be aware, the necessity of and means to an early diagnosis, the limitations of plain film radiographs, as well as the current medical treatments. CLINICAL FEATURES: A 27-year-old male professional soccer player had a tight and achy right hip for approximately 6 years, a condition that increased with physical activity. His active range of motion was limited by 25% in extension and abduction, and all resisted ranges of motion produced pain. After an equivocal radiograph and bone scan, magnetic resonance imaging revealed a subchondral defect located on the superior aspect of the right femoral head, consistent with avascular necrosis of the femoral head. INTERVENTION AND OUTCOME: Presurgical management included Cybex testing, massage, myofascial release, interferential current, muscle strengthening, and muscle balancing exercises 3-5 times per week for 5 months. The patient underwent a curette procedure. Six weeks later, he returned to the chiropractic office for postsurgical rehabilitation, in which he is still involved today. He has made progress with respect to flexibility, strength, and muscle coordination. CONCLUSIONS: Idiopathic avascular necrosis of the hip is a clinical entity characterized by pain in the hip made worse with activity and at night, which may radiate to the groin, back, or thigh. Often, physical exam and radiographic findings are equivocal, at which point advanced imaging such as magnetic resonance imaging should be ordered to identify the disease in its earliest stages.

Adult↗
PubMedDate not supplied

Clinical experience with a new hip-knee-ankle-foot orthotic system using a medial single hip joint for paraplegic standing and walking.

The Walkabout is a new hip-knee-ankle-foot orthotic (HKAFO) system with a medial single hip joint (MSH-KAFO) invented by S. McKay in 1992. Compared with other HKAFO systems, the hip joint part is compact and removable, so it has distinguishable, real merits: ease in donning and doffing the device, compatibility with a wheelchair, and cosmesis. We clinically tested five patients, paraplegic because of spinal cord injury, using the MSH-KAFO system. All were males, aged 26-36 yr old. Their functional levels were L-1 (2 cases), T-10 (2 cases), and T-5 (1 case). All patients could stand stably without crutches and walk in parallel bars immediately the first time they wore the braces. After a few hours of crutch-walking exercises, all could walk independently with Lofstrand crutches. Their walking velocities ranged from 10 to 37.5 (mean, 19.9) m/min at the follow-up points (mean, 7.1 mo). With four cases, we measured oxygen uptake for predictions of energy consumption. At comfortable walking, predicted energy consumptions were from 1.31 to 3.89 (mean, 2.75) METs. Compared with the data in literature, these seemed to be at the same level with normal walking and lower than the KAFOs walking level. Our results suggest that MSH-KAFO is a very convenient standing and walking device for paraplegics and is compatible with wheelchair use.

Adult↗
PubMed2002

[Total hip arthroplasty (THA) for the osteoarthritis of the hip joint].

On total hip arthroplasty,there are some kinds of surgical approach. In all cases the operators should perform THA with skillful surgical approach. They ought always consider normal anatomy of hip joints,and then do the surgical performance. Total hip arthroplasty which is performed with trained surgical protocol and reliable anatomical knowledge is successful certainly.

English Abstract↗
PubMedDate not supplied

Effect of a video intervention on functional recovery following hip replacement and hip fracture repair.

Although much research has documented the functional outcomes in hip repair surgery, few studies have identified effective interventions to improve functional outcomes. The purpose of this study was to test the use of generic and individualized videos on patients' return to preoperative levels of independent functioning, increased physical performance, improved coping ability, and enhanced perception of ability to care for self. Two rehabilitation units in separate acute care facilities were used to recruit subjects. Data were collected on 82 participants on admission to the study, on discharge from rehabilitation, 1 week after discharge, and 3 months post discharge. The results indicate that video intervention has some benefit to persons recovering from hip repair surgery. The benefits were realized in physical performance as evidenced by a significant difference in the distance walked and time walked of participants in the treatment group.

Activities of Daily Living↗
PubMed1991

Telemeterized in vivo hip joint force data: a report on two patients after total hip surgery.

Two telemeterized femoral components were implanted in two patients as part of normal total hip replacement procedures. The two components were instrumented to measure the three force components directed along: (a) the neck axis, (b) transverse to the neck axis and in the plane of the prosthesis, and (c) transverse to the neck axis and perpendicular to the plane of the prosthesis. Data were collected at multiple sessions during the early postoperative period for a number of standard activities, including gait, stair climbing, rising from a chair, single leg stance, double leg stance, ipsilateral and contralateral straight leg lifts while supine, ipsilateral flexion and extension while standing, and ipsilateral abduction while standing and lying on the contralateral side. These data are summarized and compared with the published results from analytic studies and with the results from previous studies using instrumented femoral components. Peak loads for gait during the period of study were roughly 2.7 body weights (BW) when the patients walked at their normal pace. Contact forces at the hip during stationary single leg stance approximated the peak loads during gait with values ranging from 2.1 to 2.8 BW. The highest forces recorded reached values approaching 5.5 BW and occurred during periods of instability while the patient engaged in stationary single leg stance. Our in vivo data indicate that forces generated during the above activities increase in magnitude quite rapidly during the early postoperative period and that during this period the patients have the ability to perform the activities of daily living without generating the high amplitude joint contact forces suggested by the results of dynamic studies. Joint contact forces during gait were found to depend on speed, but the high absolute magnitudes predicted by model studies were not supported by the in vivo data.

Aged↗
PubMed1982

A cementless system of total hip prosthesis. Experimental studies on total hip prosthesis in dogs.

It is essential that the prosthetic material should not be harmful to the human body, it should be strictly fitted to the body and it should have sufficient durability. To investigate those conditions of an artificial joints as mentioned above, it is important to have experimental studies using a model of the artificial joint in animals instead of a simulator. The authors have developed their own total hip prosthesis for a dog since 1970. These prostheses were fixed to the bone without bone cement. These dogs were killed periodically from 8 weeks to 3 years after surgery of total hip replacement. Not only were pathohistological studies on the joint capsule and bony tissue of the femur surrounding the prosthesis performed, but also scanning electron microscopic examination on capsule and the surface of the prosthetic head were performed. The results were excellent. Ther was no loosening or wear when the new type of acetabular socket with large spikes was used. On the other hand, in the case of the old type socket with its smooth surface and smaller spikes, loosening of the socket and prosthetic stem occurred within one year after surgery.

Animals↗
PubMed2005

Accuracy of an electromagnetic tracking device for measuring hip joint kinematics during gait: effects of metallic total hip replacement prosthesis, source-sensor distance and sensor orientation.

The present study sought to investigate the effects of source-sensor distance, sensor orientation and the effects of metallic total hip replacement (THR) prostheses on the accuracy of the 3Space Tracker System (3STS). Using a simulated hip joint, the angles measured by the 3STS with six different source-sensor distances and two source-sensor orientations were recorded. Then the angles measured in the absence and presence of three different THR prostheses were compared. Both source-sensor distance and sensor orientation affects the accuracy of the 3STS. Measurements were only affected by the presence of one type of prosthesis. The 3STS was equally reliable, but less accurate with source-sensor distances of more than 25 cm. The small angular error and insensitivity of this device to the presence of some metallic THR prostheses make it a useful measurement tool for gait studies performed before and after THR surgery.

Arthroplasty, Replacement, Hip↗
PubMed1991

Canine intersegmental hip joint forces and moments before and after cemented total hip replacement.

Intersegmental forces and moments (i.e. resultant free body forces and moments computed at the joint centers) were studied in canine hindlimbs before and after cemented total hip replacement (THR). Five large, adult, mixed-breed dogs were selected. Their gait was recorded (while leash-walked) before surgery using high-speed cinematography and a force plate. Cemented total hip replacement was unilaterally performed on each dog. Gait was again recorded at one and four months after surgery. Segmental properties (mass, center of mass, and mass moment of inertia) of the hindlimbs were experimentally determined, and an inverse dynamics approach was used to compute intersegmental forces and moments in the sagittal plane. Significant reductions in intersegmental joint forces and moments were observed in the operated hindlimb one month after surgery, although kinematic gait parameters were unaltered. Decreases of 77.0% for vertical forces, 61.9% for craniocaudal forces, and 66.2% for extension moments were determined. Four months after surgery, the joint forces and moments had returned to their preoperative values. This experiment demonstrates that the dynamics of normal walking can be restored in a canine model by four months after THR. It also shows that kinetic (rather than kinematic) parameters are more descriptive of antalgic gait in the canine.

Animals↗
PubMed1992

Bone scans in patients with osteoarthritis of the hip for the evaluation of bipolar hip arthroplasty: quantitative analysis using SPECT.

To establish the time-course of bone scans after bipolar hip arthroplasty (BHA) bone scanning was performed before and after surgery in 22 hips. The influence of migration of the outer head into the acetabulum on the time-course of bone scans was examined by analyzing the relationship between the uptake of radioisotope and the magnitude of migration. The bone scans were quantitatively analyzed by single photon emission computed tomography (SPECT) on the basis of the ratio of radioactivity at the acetabulum to that in the anterior superior iliac spine (ASIS). The increased radionuclide activity decreased exponentially to a baseline with time after surgery. The postoperative uptake ratio could be expressed as a function of the preoperative uptake ratio and the postoperative length of time. The regression slope representing the decreasing rate of uptake showed no significant differences between two groups divided by the magnitude of migration of the outer head. Migration of the outer head was considered not to influence the time-course of the bone scans.

Adult↗
PubMed2004

The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery.

The exclusion of infection is the most important factor in determining treatment options in a failed hip arthroplasty. Preoperative biopsy in the form of aspiration or tissue biopsy can be used to diagnose infection. Preoperative aspiration and tissue drill biopsy were performed in 273 consecutive patients under general anesthesia 3 months before exchange arthroplasty surgery. The results of the preoperative aspiration and tissue biopsy cultures were compared with the definitive intraoperative tissue cultures obtained at surgery. Seventy-one of 273 (26%) hips were infected. Overall accuracy of aspiration was 90.1% and tissue biopsy 87.9%. The sensitivity and specificity was 80% and 94% for aspiration and 83% and 90% for tissue biopsy. Positive predictive value and negative predictive values were 81.4% and 93.1% for aspiration and 73.8% and 93.8% for tissue biopsy. The more invasive tissue drill biopsy offers no advantage over aspiration in terms of bacterial accuracy and results in more false positives.

Arthroplasty, Replacement, Hip↗
PubMed2005

Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips.

Long-term survival of the acetabular component in revision total hip arthroplasty (THA) is determined by initial implant stability and bone ingrowth. Highly porous Trabecular Metal (TM, Zimmer, Inc, Warsaw, Ind) facilitates ingrowth and may be an ideal material for revision THA. The outcome and survivorship of a TM, nonmodular, uncemented acetabular cup were assessed in 60 consecutive patients undergoing revision THA (mean follow-up, 42 months; range, 14-68 months). Most (55/60) acetabular cups were implanted without screw fixation. Mean Harris Hips Scores improved from 74.8 preoperatively to 94.4 at last follow-up. Serial radiographs demonstrated excellent bone apposition and bone graft incorporation. Complications were limited to 7 cases of dislocation and 1 revision for aseptic loosening. The TM acetabular cup appears suitable for use in revision THA and warrants further study.

Acetabulum↗